Important Insurance Update for Austin City Dental Patients
Austin City Dental remains an independent, fee-for-service dental practice. Dr. Steve Cook recently shared an update explaining changes to how our office verifies dental insurance benefits.
Dear Friends,
My goal as your dental provider has always been to deliver the highest quality care and educate you about your health and options for care. Part of that process has historically involved verifying your insurance benefits before the time of service. When I took over this practice twenty years ago, Dr Goldsmith and Dr Krumholz were out-of-network with dental insurance companies. I continued this practice because I had seen both sides of the coin in my early years of practice, and I did not like working in high-volume insurance driven practices. The focus was less on quality and more on volume.
I could either sign up as a preferred provider with a bunch of insurance companies and see as many patients as possible or I could remain independent and focus more on developing relationships and spend more time with my patients, as well as use the best labs and materials that go in your mouth. When a doctor signs a contract with an insurance company, you agree to only charge what the insurance company dictates.
Their fee schedules are much lower than a typical fee and therefore dentists are forced to increase the volume of care and nickel and dime you with extras like X-rays every six months, fees for local anesthetic, and often larger treatment plans that are often unnecessary.
We see many patients every year for second opinions that have been to an in-network dentist because they were told they need a lot of treatment and their gut told them something is fishy. Most of the time we find that the majority of the treatment is completely unnecessary. Unfortunately, this has worsened in the last decade as private equity has become a huge force in dentistry. Large corporations (Dental Service Organizations or DSO’s) are buying up as many dental practices as possible and usually keeping the practice name the same so that patients aren’t aware of the changes. This turns patients into nothing more than a number and everything is focused on the bottom line of profit. They often bring in young dentists straight out of school and push them to do as much dentistry as possible to maximize their profit. Few things make me madder than healthcare being ran by corporate overlords.
Dental insurance companies are in cahoots with these DSO’s because the majority of these dental practices are all in-network with the insurance companies and everyone profits when they work together. Thus, the insurance companies are intentionally making it more difficult for out-of-network (OON) dentists to get information regarding the insurance policy, even if the policy pays benefits to an OON dentist. Over the past several years it has become increasingly difficult to verify your insurance benefits as an OON office. They make us wait on hold for hours before answering, they send us to websites that barely work or give us poor information. Oftentimes, the websites are down and not even accessible. This is their way of trying to drive us in-network and make you, the patient, get frustrated with us because we cannot give you good information regarding your benefits.
Effective immediately, we will continue to verify that you have an active policy, but we will not be verifying your benefits because it has become untenable. We will collect payment in full at the time of your appointment and then file a claim with your insurance and have them reimburse you directly. You will receive an Explanation of Benefits (EOB) with your reimbursement and if you feel something was denied that should have been covered, please contact us and we will appeal it for you.
I know this is a big change for some of you and this decision was not made without much thought and discussion. We pride ourselves on being an independent practice driven by patient care and developing rapport with our patients. Your trust is something we take very seriously, and by remaining independent we are able to provide a level of care and customer service that you will not find in insurance based practices. We value each of you as patients and encourage you to contact us with any questions you may have. We will continue to do everything in our power to help you maximize your yearly benefits.
Best Regards,
Dr Steve Cook
Austin City Dental
